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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -8 BOX 19 02217 r. ` 02217 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR. A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: BETTY O'DELL WICCOPPE ROAD PUTNAM VALLEY, NY 10579 2. Name of project: BETTY O' DELL 3. Location TN" TOWN OF PUTNAM 4. Design Professional: JOEL GREENBERG 5. Address: 2 MUSCOOT ROAD NORTH 6. Drainage Basin: MAHOPAC,NY 10541 7. Typq of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ...................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... NO 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency N/A 12. Is this project in an area; iinder the control of local planning, zoning, or other _ ......__.Df_ftcials,. ordinances?.._-....:.................. r. .............. .�w..�.:...z.1.....r:........ 13. If so, have plans been submitted to such authorities? ........ ............................... No 14. Has preliminary approval been granted by such authorities? No Date granted: 15. Type of Sewage Treatment System Discharge ...........:..... surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ............................................ ............................... N/A 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply N/A Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ................ NO 21. Name of sewage system N / A Distance to sewage system N /A 22. Date test holes observed 6/13/00 23. Name of Health Inspector ADAM STIEBELING 24. Project design flow (gallons per day) ................................. ............................... 600 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 8/99 7 27. Is any portion of this project located within a designated Town or State wetland? No 28.. ... Va._ .. _ /A -_ _ r,.. 29. Is Wetlands Permit required? .............................................. ............................... No Has application been made to Town or Local DEC office? ............................... N/A . 30. Does project require a DEC Stream Disturbance Permit? .. ............................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No No 11) 21-141 a Wis 33. Is there a local master plan on file with the Town or Village? ......................... YES 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... NO 35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO 36. Tax Map ID Number ............................. ............................ Map 41 .5 Block 1 Lot 8 37. Approved plans are to be returned to ..... Applicant Design Professional -- - NOTE-.. All-applications, for - review and approval of-a- new SSTS to= be-located withiirthe-NYC Watershed - shall- ` be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNAT U ES & OFFICIAL TITTLES. VWNZA Mailing Address: ................................... WICCOPPE ROAD PUTNAM.VALLEY, NY 10579 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner' BETTY O' DELL Address WICCOPPE ROAD, PUTNAM VALLEY, NY 10579 Located at (Street) OAKRIDGE Tax I Map 41 5-Block 1. Lot 8 (indicate nearest cross street) Municipality TOWN OF PUTNAM VALLEY Watershed HUDSON RIVER Date of i SOIL PERCOLATION TEST DATA Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, 5 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole.' Form DD-97 Depth " t 0' a t e r: mater er .. ........ ...... Guh e ... . .......... . .. . .... . . u . .. . ..... .. Time ... ' .... 0 e V Surface Stab .: : 9 ne ..... . . .... 8:00-8:16 16 22.5-25.5 3 16/3=5.33 2 8:17-8:33 16 r. 22.5-25.5 3 16/3=5.33.. 3 6:34-8:50 16 22.5-25.5 3 16/3=5.3 4 5 2 —8: 2 8:24-8:43 19 23-26 3 19/3=6o.33 3 8:44-9:03 19 23-26 3 19/3=6.33 4 5 2 3 '5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, 5 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole.' Form DD-97 TEST PIT DATA 2 (DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE N0. 2 HOLE NO. G.L. TOPSOIL TOPSOIL 0.5' . STT.TV SAND SILTY SAND 1.0 FOAM FOAM 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' - 5.5' 6.0' 6.5' 7.0' 7.5' . -_.. 8.0' 8.5' 9.0' - -_... _.._�....._.___ __ _.._ �...... _..._._ 9.5' 10.0. Indicate level at which groundwater is encountered 5 FT Indicate level at which mottling is observed N/ A Indicate level to which water level rises after being encountered 5 FT Deep hole observations made by: ADAM STIEBELING Date 6/13/00 Design Professional Name: JOEL GREENBERG Address: 2 MUSCOOT ROAD NORTH � I 1C�aED QRp Signature al �A I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of BETTY O' DELL Located at OAKRIDGE DRIVE TN PUTNAM VALLEY Tax Map # 41.5 Block 1 Subdivision of 5TH�;�MA•P_� ' OF ROARING BROOK LAKE Lot 8 Subdivision Lot # 5 0 4 Filed Map # 3 Q 9 Z Date Filed 7/1 / 4 9 Gentlemen: This letter is to authorize JOEL GREENBERG -, a duly licensed Professional Engineer or Registered Architect XX =X to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply system's in conformity with the provi icle 145 and/or 147 of the Education Law, the Public Health. Law, and the Putnam ode. v`C;p �A A Very truly yours, Countersign � � � Signed: `�� geze P.E., R.A., # (Owner of roperty) Mailing Addres MU CO NORTH Mailing Address: WICCOPPE ROAD MAHOPAC State NEW YORK Zip 10541 Telephone:`` 914) 628: -661 3 PUTNAM VALLEY State NEW YORK Zip 10579 Telephone: ( 914) 528-4162 Form LA -97 I 7/19/2000 PUTNAM COUNTY HEALTH DEPT. GENEVA ROAD BREWSTER, NEW YORK 10509 FAMEMMON O'DELL, MARVIN & BETTY I 91 P PRINTS CQ S SPECIFICAT ® S SHOP DWG El S SAMPLES E:l O OTHER APPROVAL- El YOUR USE ® REVIEW ® COMMENTS COMMENTS: PLEASE FIND EN( FROM JOC-L GREENBERG fil ec TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628-6613 FAX 628-2807 8/16/2000 PUTNAM COUNTY DEPT. OF HEALTH GENEVA R, AD B WS REWSTER, NEW YORK 10509 ADAM STIEBELING BETTY ODELL m I I Dp n� nQ COMMENTS: ENCLOSED PLEASE FIND REVISED DRAWINGS AND APPLICATION REGARDING BETTY ODELL. FROM J09L (;Rg;;NeC-R(;, R.A. COPIES TO: BRUCE. R. TOLEY _... . Public Health Director August 29, 2000 _LORETrA MOLI- NARI- A. _IM.S$J:,__ Associate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 (/� Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 ( o 0 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Joel Greenberg, RA 2 Muscoot North, RFD #2 Mahopac, New York 10541 Re: Application to Construct a Subsurface Sewage Treatment System on Oakridge Drive, O'Dell (T) Putnam Valley, TM# 41.5 -1 -8 Dear Mr. Greenberg: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on August 17, 2000 remains incomplete. Please be advised that the following information is required before the Department may commence its review. Documentation: 1. Application Form CP -97 * Lct•a eaxnt,.st be- corrplcted.... _:. _ a.._ ......... _ 2. Application fee of $100.00 Certified Check required for "new" well on TM# 41.5 -1 -7. 3. Application Form LA -97, complete filed map number. 4. Provide a Letter of Authorization from TM# 41.5 -1 -7 for re- drilling of well. 5. Provide Neighbor Notifications for both proposed activities on TM# 41.5 -1 -7 and 41.5 -1 -8 pursuant to PCHD Bulletin ST -19. Plan: 1. Locate well as acceptable to Lot # 41.5 -1 -7, Show on plan. 2. Provide dimensions to locate well on TM #.41.5 -1 -7. 3. Design criteria states "1250" gallon septic tank, plan shows 1000 gallon tank, please clarify. 4. Complete "Putnam" in Basic Required Notes. 5. Remove all details from plan detail sheet that are not applicable and "X" out. * There are more details "X" out than applicable on plan. This office reserves its right to further review and will do so upon receipt of "revised" plans. .v . ra ♦ ..... .�..j ... s.a x. _ .. i :.1 -... .... .. ... ...... . .— .:-n.. .... .. c ...- ca - w. ^n n, ._. .. .. , >..... >..cw ._ .a ... e. a... ..., ... .. ._.... .. ... .... ... The review of your application'will commence once the Department receives the requested information and determines that the application is complete. The Department will, notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficientgrounds to deny approval, pursuant. to the New ;York City Department of Environmental . Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at (845) 278 -6130 extension 2157. Very truly yours, Adam B.-Stiebeling _... _... _ ......._. Assistant Public Health Engineer ABS:cj BRUCE R. FOLEY Public.. _Health PjCq)ctor„ •- - • • - _.. _. June 14, 2000 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETfA MOLINARI R.N., M.S.N. --Associate -Public Health- •;Director; .- :;, Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 ]Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278-6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Joel Greenberg, RA . Two Muscoot North, RFD #2 Mahopac, New York 10541 Re: O'Dell, Oak Ridge Drive _ Roaring Brook Realty Subdivision. Lot #504 Town of Putnam Valley Dear Mr. Greenberg: �� . l /Cptp.E 0 Y, ��' This letter is to confirm the witnessing of deep test holes on the above referenced parcel on Tuesday, June 13, 2000. Prior to further review: 1. Provide this office with a preliminary design of the system for its review. 2. Large boulders as shown on "survey" to be considered ledge rock if not moved. Minimum separation ledge to SSTS is 10'. 3. If "boulders" are proposed to be moved, additional deep test holes will be required for soil testip -i -SSTS is to be pri�uosed,below rock bounders:: * Boulders to be removed prior to approval. 4. Based on the size of the lot and potential two bedroom house, this office will be required to witness soil percolation testing. 5. Please provide location of SSTS for adjacent lots # 503 and 505, well for lot # 503 and all ` wetlands in area. 6. Minimum separation from open drainage pipe is 50.0'. Minimum separation from closed drainage pipe is 35.0'. As discussed, this office will continue its.review upon consideration of the above mentioned comments. Please.. feel. free to contact me at ext. 2157 if,any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj BRUCE R. FOLEY . .• . Publie Health �Director u .... , .,... ,,., .,...._«,..-.., ...r April 14, 2000 LORETTA MOLINARI R.N., M.S.N. ..... -� ._.. � <. •Associate • Pubh c :.��lea.�th••Di�ctor•�.....�._ .. �,.. <.. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278.6648 Joel Greenberg, RA Two Muscoot North, RFD #2 Mahopac, New York 10541 Dear Mr. Greenberg: Re: O'Dell, Oak Ridge Drive Roaring Brook Realty Subdivision. Lot #504 Town 'of Putnam Valley This letter is to confirm the witnessing of deep test holes, on the above referenced parcel on Wednesday, April 12, 2000. Prior to further review: 1. Provide this office with a preliminary design of the system for its review. . 2. Large boulders as shown .on "survey" to be considered ledge rock if not moved. Minimum separation ledge to SSTS is 10'. 3. If "boulders" are proposed to be moved, additional deep test holes will be required for soil testipg..:� Boulders to be removed prior to approval. 4. Based on the size of the lot and proposed two bedroom house, this office will be required to witness soil percolation testing. 5. Please provide location of SSTS for adjacent lots # 503 and 505, well for lot # 503 and all wetlands in area. 6. Minimum separation from open drainage pipe is 50.0'. Minimum separation from closed drainage pipe is 35.0'. As discussed, this office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant 'Public Health Engineer ABS:cj d ...- BRUCF_ :R.J.-1 OUE,Yz... - Public Health Director _._.r.. ... . . Mm LOPEl7A- _MOLINARI _,.P- N.,,.M.S.N ... _ - Assotciote`'Priblic Haolth Dire% for ' Director of Patient Services DEPARTMENT OF HEALTH li Geneva Road Brewster, New York 10509 R=JEST -'FOR FIELD TESTING ATTENTION: WADAM S'T I EDELING o GENE REED All information below trust be f44 completed prior to any scheduling. PRATE: 4/5/2000 ENGIINEEROR>FIRM: JOEL GREENBERG, R.A. PHOKE #: 628 -6613 DEEPS: &C PERCS: ❑ PUMP TEST: O ROAD/STREET: OAKRIDGE DRIVE' TOWN: PUTNAM VALLEY TAX MAP #; 41.5 -1 -008 SUBDIVISION: ROARING BROOK SUBDIVISION 11,0 T#. OWNER: BETTY RADOCAJ O' DELL NYCDPEIP CRITERIA. lE6Dlt .l 1(td"T'!EVREW AND OF .5011, 6'ERYNG YES Nn O ]b . Proposed SS'T's within the drainage basin of West Branch or Boyds Corner Reservoirs. o IV Proposed'SS'T'S within 500; feet of a reservoir, reservoir stern or control lake. D DJ Proposed SSTS within 2001 feet of a watercourse or a DEC wetland. :❑ :. }D._ prape�id.SS'i'S_ddigwog gMater than 1000,galions,/day or S;PPPDES hermit required_ C1 )p Proposed SSTS for a Cominerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered j&-s to any of;the questions, MYCDEP trust witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the pCOOH, the Design Professional and NYCD1EP. If a project has been determined to be Pelegated based on the above response and then subsequent information indicates NYCDEp is required to witness the soil testing, it will be the sole responsibility of the desitrm nrel'essional to schedule re- wiitnessinrt of the soil testine with KYCPDEP;a. ObR COUNTY USE ONLY DATE: 4'{�'� TEME: o �� t_XIMMF.NT! MELD1'FST) TOTAL P.02 JAN -19 -2000 03:22 1,7 "4 19 1 ' • ..�� ` _ e 1 / 11.0 At. tu.l I I (.l R Aw IIGI sm 1 ` LUE PARK 1 r � \ jw ; r e Q A AV � jw 6 I 0 fAl. v v ,P.M 41 as • 1.9 1f J' I P. 02 w a.wr�... +.r�.) ... af.'!n '.- ♦.� �. ar..a•.rM rlrwv n., a TOTAL P.02 r. :• ._.._. .. JAN -19 -2000 03:21 P.01 Two Mmecooff Road North ma kopac, New Ydi* '10 4 ._..... , _ . , ._.. . .. 0 Ffiv 989 -628 -2807 @-mIl: )LGARCDI@Sol.com [DTBo ATTENTION: IFAX HUMBER: TRUK CUMMEN S: AF YOU DON'T RECEIVE- ALL RIA (.Fl OF TRANSMISSION, PLEASE CALLUS AS SOON AS POSSIDLE. TOTAL NUMBER ®.F ADAGES 4QN4:�.H��D�l�� 1I!l�A� §I�d'd Il�1�. S�iItE1E7�: 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL REALTH SERVICES -- JNITT AL 'DIVIDLJAL /C017�IERCi:� L`SITE IX§kCTION FORMI SECTION A. GENERAL I. FORi12ATION -Name of Project OD f91U1L__ (T)(V) County I Site Location Building construction begun L1 Extent Is property within NYC Watershed ? ................. Yes i .o SECTION* B. TOPOGRAPHY (Please check all appropriate bo s) 1. Hilly Rolling Steep slope eatle slope ❑ Flat 2. ❑ Evidence of wetlands Low area s1bject to flooding �aulaee ditches oek outcrops 3. Propea lines or comers evident ...............:....... ............................... 4. Do water courses exist on or adjoin the properly? ............................ ❑ Bodies of water <es les ❑ No No 1�0��° �',z� 5. Will these aL, ct the design of the 'sewage system faciliti.s ............ Yes � No 6. Do watershed regulations apply in this development ? ...................:... Yes 12,<o 7 Will ext:nsiv.- grading be necessary?? ................................................... Yes �No 8., Will extensiv a fill be necessary. for. SSIS ?.�.:.....:...... �...,.r:.��:R; ::i -- Yes io 9. Do filled areas exist within the SSTS area? ........ ............................... es. ❑ No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sa/nd Gravel Low ❑ Clay ❑Hardpan Elgix 11. Observed from: ❑ Borings ❑ Bank cut Ei ack oe excavations 12. Soil borings/excavations observed by z on t IV Iro 13. Depth to groundwater 1 -0 tr on 14. Depth to mottling j tom+ on V. 15. Are test holes representative Hof primary & reserve areas ..... .............:................. Yes ❑ No 16. Soil percolation tests made by on 17. Soil percolation tests NAtnessed by on SECTION D (on back) Form ST -1 1) ECTIOIS'D. DRAINAGE 9., , NWt,1pr'o'po'sed grading materially alter the natural draiiiiag'e. in this or adjacent areas? ? Ye No 9. Will grouidwater or surface drainage require special consideration? .................... e � No 5 tO. NI ill gullies, ditches, etc., be filled . and watercourses be relocate . d? ......................... . Yes -�No SECTION E. RENLkRKS �c gam' � . 21. If a common water supply is proposed, has an inspection been -made of the existing or proposed source and facilities? ................................................................ Fl Yes 0 Inspection data e systems es ystems exist? ..................................................... 22. Do adjacent wells and /or sewaa E2�f [--I No 23. Additionall.comments 24. Site observerlinspecior and title 25. Da,.-.(s)o'Llobservation(s)inspection(s) kop" L_ IV 1'2-) 0 0 TEST PIT PROFILES Hole Lot Irl Hole z'_ Lot E Hole F' Lo 0 e Depen to water Depth to water th to Depth to water Depth Depth to mottling 04,.,f Depth to mottling Depth to iri6ttlikig — .Depth to p D 16 roc imp._ Depth to roc'eJ Pp. Deptn to Depth to rock/imp G.L. G.L. G.L. L e) -r-e G.L. 0 OS 0.5 . 4, 0 5 4r 0.5 ca c> L (0(( 1.0 0, 1.0 1 0. �)4 -77 < 1.0, 3.0 3.0 1.0 4.0 0 12,' 3.0 i.o CB " —4-,e 1> 0.0 - slrj / \11 .0 5. l2'1'1 - 4( , 6.0 6.0 7.0 71C 9.0 9.0 10.0 10.0 p, locator. .,.. - Parcel \ this ad/o in v. 78.' T 503 ' LO o 22,2.74' 22• %4 Al >/ e r ,� s O h a / �' Cl 4 m� o � � G r N . (4 , At tft AIIIIIIIII�Dfl a , M Q i LOT 50z tQ) 7 F � s r— N JS FIB f ;T N 4978'10' W r ` T. 268.25' 4 ieputed location of buried wed/ as. por owner and as indicated FR t b '077 nefk locator reading. 'QME y 9 9 u$ v (to 'be conTrmed by engrn r� �H� E f 306DS6f IttS LOT 0 �. X15 10 0 0 � � Sk Slope Fahnesh State ir Po V -L LE'Y I .: dings Street Uple Use Area r I '/ � `4�]A�' 0" S 10512 910 1chavdsvilie � am- '� - rIN-fi f# R ly L ke ake Tibet" Pj pv..� FOR ADJOINING AREA SEE MAP NO.6 .00 .. . H ADAM 1054 PrUTNAM`,---VA 10579 Pud f 0 aP F, Of J `� \ U `` R_D 40 10 All ir Po V -L LE'Y I .: dings Street Uple Use Area r I '/ � `4�]A�' 0" S 10512 910 1chavdsvilie � am- '� - rIN-fi f# R ly L ke ake Tibet" Pj pv..� FOR ADJOINING AREA SEE MAP NO.6 .00 .. . H ADAM 1054 BRUCE R. FOLEY .. -: ^ Public• ~f�ealth' Director:•',, .`"' .._"' ° ,'. �..... ` ." . LORETTA MOLINARI,R_.N., .•...,4 Associate Public `Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York ;10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 ©0 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 O Early Intervention (845) 278 - 6014 Preschool (845)278 -6082 Fax (845) 278 - 6648 Joel Greenberg, RA 2 Muscoot North, RFD #2 Mahopac, New York 10541 Re: .A:pplicatiol to Construct a Subsurface Sewage Treatment System on Oakridge Drive, O'Dell (T) Putnam'Valley, TM# 41.5 -1 -8 Dear Mr. Greenberg: j c� l�1 'Zpv2 tR -�aeS 1 acea�t,urc- •�•y�. The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department one e. Please be advised that the following information is required before the Department may commence its review. Documentation: 1. Application Form CP -97 J16 Lot area must be completed. - -Application fee -of'$100.00'Certified'Check r'equued "for "new " -well on TM# 41.5 -f -7.- 5A. Application Form LA -97, complete filed map number. �. Provide a Letter of Authorization from TM# 41.5 -1 -7 for re- drilling of well. .i Provide Neighbor Notifications for both proposed activities on TM# 41.571 -7 and 41.5 -1 -8 pursuant to PCHD Bulletin ST -19. S y„Frr V z.,, 4 > as requued. Plan: Lae,om*- l- -� #-, - Vf�,t,5✓. 70 t --. r' ` '1 1. Provide dimensions to locate Fell on TM# 41.5 -1 -7. ea ers. n, pan 24,-fw Design criteria states "1250" gallon septic tank, plan shows 1000 gallon tank, please clarify. 4. Complete "Putnam" in Basic Required Notes. 5. Remove all details from plan detail sheet that are not applicable and "X" out. * There are more details "X" out than applicable on plan. Si•IDC,.� �N This office reserves its right to further review an d will do so upon receipt of "revised" plans. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at (845) 278 -6130 extension 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. FYENVIIZOT�!!�E1�T'I' ..,_.. -._..O AL'HEALTH:SER�VICES:...,.:.... .. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # QV- 31S -oc) Located at 'Z'J OIL Pte► She" Owner /Applicant Name zeaoT 1�; Town or Village 1P0.a-AM VAL"_F_y Tax Map Al- 1!5 Block i Lot 6 Formerly 0105L�- Subdivision Name O)A? Sub d. Lot # Mailing Address �Q� y� �V 1l��rl_T� ( rNS �I� IOf& Zip Date Construction Permit Issued by PCHD q O1z Separate Sewerage System built by _ 45iAC" .. Address bvc* ltaLa-i;0 Q-9 60Aac- Consisting of 0 Gallon Septic Tank and �3�00 (..I^ Other Requirements: Water Supply: Public Supply From. Address or: Private Supply Drilled by i.:u� Address Ae&, , • b�✓ wilding Type -- -- it Has- erosion-control been completed? Number of Bedrooms Has garbage grinder been installed? 0.1v I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulation f the Date: / l b Certified by Address Department of Health. P.E. R.A. License # � a57Q!r Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. 0S By' Title: Date. WVecopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 r , ' BRUCE' ' R:- F61:E Public Health Director "LORETTA MOLINARJ 1ZN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH- 1 Geneva Road Brewster, New York 10509 Environmental Health (914).278 - 6130 Fax (9.14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 I � I :. III !1� i °' I �/I "' ! I � ., I I �/� _\ I i�� I'' ►/1 OWrN ER.S NAME: TAX MAP NUTIVIBEEU: E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: U,C%litA'Ct. l LV- �� W -4UX-tll" (Signature) d DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E9111 address is assigned.by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRK PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT will Location S et Address: MQfgL,-.-jMap41,5 ilt j Tax Grid # Block 1 Lot(s) Well Owner: Na Address: Use of Well: 1- primary 2- secondary >e- esidential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing ca/ Open hole in bedrock _ Other Casing Details Total length / Length below grade 'eft. Diameter in.' Weight per foot �lb /ft. Materials: Steel Plastic Other Joints: _ Welded ,�- Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: _X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _Pumped .Compressed Air Hours Yield /0 gpm Depth Data Measure from land surface- st$tic (specify ft) � During yield test(ft) Depth of completed well in feet 300 Well Log If more detailed information descriptions or sieyr; analyses : ::._ are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface G o 4 _ ,.. _ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity -- VA* -% Depth -Z BO' Model 6& J t Voltage 20 HP _P2- Tank Typed Volumef� Date Well Completed /�' v3 Putnam County Certification No. Date of Report A13 )(j We I Dril er (signature) -� !VOTE! hx4ct location of well with distances to at least two permanent ent la lawarKs to De proviaaea on a separate sneeupian. Well Driller's Name t�€ `'�`' ��,�. "" �>�!% Address, Z' �-/ .fir Signature: t'J4 ,%� Date: Q White copy: HD File;: Yellow copy - Building Inspector; Pink copy - Owner; Orange - Well driller Form WC -97 S�xtii,'Fi. F` UTNAM COUNTY DEPXRTMtENT DE HEALTH DIVISION OF ENVIRONMENTAL H -EALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ��e� Owner or Purchaser of Building Building Constructed by Location -Street Building Type Tax Map. B` lolck Lot Town/Village Mw5, oc- e - Subdivision Name FM W_ 30f6_ _: Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years. immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. _ ..._ _ ... The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month . Day j Year al Contractor (Owner).- Signature Corporation Name (if corporation) Address: A3 State _. „G Zip $: Signature: ^� Title: Corporation Name (if corporation) Address: 1�o LLot-i Y fVm- State V�1_ Zip Form GS -97 ' YML ENVIRONMENTAL SERVICES 321 Kear Street ' H i ht ' Y.� 10598�`�z U Albert H. Padovani,/Director LAB #: 9.500444 CLIENT #: 58075 NON STAT PROC PAGE/ BAXTER, BOB DATE/TIME TAKEN: 03/08/05 09:00 25 OAK RIDGEDRIVE DATE/TIME REC'D: 03/08/05 12:00 PUTNAM VALLEY, NY 10579 ' REPORT DATE: 03/16/0-5 PHONE: (845)-621-8562 SAMPLING SITE: OAK RIDGE DRIVE : PUTNAM VALLEY COL'D BY: ROBERT BAXTER NOTES...: WATER TANK ~~~~~~~~~~=~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY 03/08/05 03/08/05 03/08/05 03/O8/05 03/08/05 03/08/05 03/08/05 03/08/05 03/08/05 03/08/05 03/08/05. PROFILE MF T. COLIFORM LEAD (IMS) NITRATE NITROG NITRITE NITROG IRON (Fe) MANGANESE (Mn) SODIUM (Na) H HARDNESS,TOTAL ALKALINITY (AS - TURBIDITY (TUR SAMPLE TYPE..: POTABLE / PRESERVATIVES: NONE TEMPERATURE..: COLlFORM METH: N/A ~~~~~~~~~~~~~~=~~~~~~~~~~~~~~~~~~~~~~~~ RESULT ABSENT 1100 <1 pph 0.71 MG /L <0.01 MOIL <0.060 MOIL 0.0191MG/L 6.42 G/L 6.5 UNITS 100 MG/[ 64.0 HG/L <1 NTU NORMAL - RANGE ML ABSENT 0-15 ppb 0 - 10 N/A 0-0"3 mg/l O-0.3 mg/l N/A 6.5-8.5 N /A N/A 0-5 N '-�^-, TU ' ' COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARnS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. . Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. � . Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium METHOD 1008 9003 9052 9162 9002 9002 9002 9043 9001 YML ENVIRONMENTAL SERVICES 321 Kear Street � Yorktown Hplobts, N M-_10598'��`,��_�������_�_�^ Albert H. Padovani, Director | LAB #: 9.500444 CLIENT 4, 58075 NON STAT PROC PAGEv 2 BAXTER, BOB DATE/TIME TAKEN: 03/08/05 0900 25 OAK RIDGE DRIVE DATE/TIME REC'D: 03/08/05 12:00 PUTNAM VALLEY, NY 10579 REPORT DATE: 03/16/05 PHONE: (845)-621-8562 SAMPLING SITE: OAK RIDGE DRIVE : PUTNAM VALLEY COL'D BY: ROBERT BAXTER NOTES...: WATER TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE is suggested. SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLlFORM METH: N//\ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY., WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. --SOFT GOFT WATER: 0-70 MG/L -- '- VERY HARD WATER: ABOVE 300 MG/L ~ --^---wi���/�����`A���)' -�7)�1l�)-�G���' - ~ l����-��'-MIl.L]7��6P�['P�F 1.I7l�R HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: aa�lp Albert H. 'adovani, M.T.(ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: . Property of — LETTER OF AUTHORIZATION Located at o <4 T/V QA Tax Map # Block �_ Lot Subdivision of Subdivision Lot # 5QA Filed Map # `��S' Date Filed d- Gentlemen: This letter is to authorize �Zq T&3' 0 , ? L!E� a duly licensed Professional Engineer ✓ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property' in accordance with the standards, rules or regulations as promulgated, by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or. 147 of the Education Law, the Public Health. Law, and the Putnam County Sanitary Code. Countersigned. P.E., R.A., # Mailing Address State ht _Zip 1664 Telephone: 74Y 4 - 2 (Z Very truly yo s, 7.. Signed: (Owner of Property) Mailing Address: �� % : M40 oN State Zip Telephone:' �v2� -"�✓�� �-- Form LA -97 i.ORBTrA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 BaviranmeaW RIth (845)278-6130 Fa: (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early InUrvwdeaffiradied (845) 278 - 6014 Fax (845) 278 - 6648 November 24, 2004 Roy FrednImen PO Box 950 Mahopac, New York 10541 Re: Field Inspection — Baxter 25 Oakridge Drive, (T) Putnam Valley TM# 41.5 -1 -8 Bear Mr. Frednksen: ROBERT J. BONDI County F- kecutivie A 'site ' pection was made for the above referenced project on November 23, 2004. The following cornplents must be corrected in the field. l . e 60 foot trench appears to have a small piece of pipe attached to the end and the pipe is twisted 209 downward. Please verify whether the pipe is attached properly so that the pipe won't separate. • . The last trench contains gravel that is not clean. The gravel needs to be removed and replaced with .. -. � .. .cleans iv h�d;giravel; prefetably•the same•gravel usca- i n- uhe�olhcr Winches::::: �3. The area around the well needs to beregraded to provide for surface water runoff away from the well. If regrading causes the casing to be less than 18" above finished grade, then the casing will have to be extended. Now 4. Please pmvie a copy of the latest approved floor plans. In reference to the compliance application already received, the well completion report is incomplete. u WQN, �"` The pump /storage tank information has not been proriided. Also, a water analysis and the Valatee 3 � Mims need to be provided. jv- ,-/ If you have any further questions, please contact me at (845)'278-6130 ext. 2157. Sincerely, Joseph. S. Pa=avati, Jr. Assistant Public Health Engineer JSP:cj Df� .......... FLAo5 LA-5--l" 5U6,.-IvV-Ttw�� LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845).278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax,(845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 24, 2004 Roy Fredriksen / PO Box 950 Mahopac, New York 10541 Re: Field Inspection — Baxter 25 Oakridge Drive, (T) Putnam Valley TM# 41.5 -;1 -8 Dear Mr. Fredriksen: ROBERT J. BONDI County Executive A site inspection was made for the above referenced project on November 23, 2004. The following comments must be corrected in the field. The 60 foot trench appears to have a small piece of pipe attached-to the end and the pipe is twisted downward. Please verify whether the pipe is attached properly so that the pipe won't separate. The last trench contains gravel that is not clean. The gravel needs to be removed and replaced with - cleap,* washed' gravel,. preferably the same gray-el _uW.ib al e T^ The area around the well needs to be regraded to provide for surface water runoff away from the well.. If regrading causes the casing to be less than 18" above finished grade, then the casing will have to be extended. Please provide a copy of the latest approved floor plans. In reference to the compliance application already received, the well completion report is incomplete. Pf n The pump /storage tank information has not been provided. Also, a water analysis and the guarantee 5'i �, forms need to be provided. Ih If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj .PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION 4, SSA �` Date: It 2 d? In t d b Street Location 1%, we- TM# 1. Sewage System Area. a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS rea ....... ... e. 100' from water course / wetlands ...... ............................... 1I. Sewage System a. Septic tank size - 1,000 .... .....1, 250 .......... other ................ b. Septic'tank installed level ......... .......:....................... .. c. 10' minimum from foundation... k.. d. Distribution Box ke. 1. All outlets at elevation -water te 2. Prot elow frost ............:::... .... .... ....................... spec e y. T P Owner,�.� Permit # Subdivision Lot gt* k li ke r �r IV 3 um 2 ft.Original soil between box & trenches Junction Box - properly set .......... .............................:. 6, Trenches, 1. Length required Length installed `7j0 2. Distance to watercourse measured Ft.. (. 3. Installed according to plan .............::........ ..4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ................. 7. Room allowed for expansion, �'. ��..!iLG^ wcti"� S. Size of gravel 3/4 2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .:.....:........... 10. Pipe ends ca ed ...:.................. ...........:.:................. 01 urh-y- or-Desed- S stems, - -- 1: Size of pump chain ......... ............ . ... 2. Overflow to ........................1.. ... ... ............... 3. Alarm aUaudio ........:........ :.. . ............................... 4. P.0 easily accessible, manhole to grade ................. �5 ":First box baffled ..... ............................................. :...... � 6. C-,ycle witnessed by H.D.estimated flow /cycle........... .:a. House located per approve plans .. .................:.......... b. Number of bedrooms ............... .... i:' Well .. Well located as per approved plans . ......:........................ b. Distance from STS area measured 4-t oO ft..... c. Casing 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... Y. Overall Workmanship . a. Boxes properly grouted .......................... . ........................ b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain dram outfall protected & dir.to exist watercourse g.. Footing drains discharge away from STS area ............... h. Surface water protection adequate.. i. Erosion control provided ................. ............................... Rev. 12/02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .......... RE: Property of LETTER OF AUTHORIZATION Located at �f'� -��� % �4:—:: T/V Tax Map # Block �_ Lot D Subdivision of bIP C> �� k2:::; ��-- Subdivision Lot # ' e LD4 Filed Map # T Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer or Registered Architect r/ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all .necessary papers on my behalf in connection with this matter and to supervise th f said wastewater tretment and/or water supply systems in conformi with the 45 and/or' 147 of the Education Law, the Public Health tY w P Law, and the Putna } Very, truly your , Counter 'gn d: �A °' °''qO ®� Signed: P.E., R A. // ®p net of Property) Mailing Address M Cj 5coo r 2DI Nd , Mailing Address: fo_ _(;z4 ( 4-7 �I State ! v - Zip State Zip o54 p g �� - 6o2Z4 - (�`� Telephone: — �2 \� g �2- Tele hone: Form LA -97 AM COUNTY DEPARTMENT OF HEALTH N OF ]ENWRONM ENTAL IHIIEALT HS ERVg ` CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM' IFEII MffT # 'PV - .35 -,OD Located at ®n Y VJ b G,t 1,-) 2.1s / r_— hAA? ,0•F- P-DO) Subdivision name aabk✓ L-Age ubd. Lot # 5-0-+ Date Subdivision Approved /A F2 Owner /Applicant Name _( �MI_ R_ t7C Town or Village AM tAl LL G a Tax Map Ja Block �_ Lot Renewal Revision Date of Previous Approval 4 Mailing Address 2-0- 14 11A A O p p c Zip l � Amount of Fee Enclosed 490-6 . 0 0 Building Type MrrPTI LLot Area Oib/ No. of Bedrooms Design Flow GPD 66 -Ca Fill Section Only Depth Volume PCH D NOTEFIICATIION IS REQUIRED WHEN ]FIILL IS COMPLETED LETEIID Selpairatte Seweirage System to consist of ! Vs E) gallon septic tank and 80® 1- E 0e Other Requirements: :7 �M, [-a I Q 1170 124 1.5 ft, 0 .t 2 AN k-", ZL ki n LL L•, To be constructed by Address t:'O L C f19 I _Wattpr Su Ile P lic Supply From Address oir: Private Supply Drilled by Rte. yAurS, N- y,10579 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating conditio54ffyVart of said sewage treatment system during the period of two (2) years immediately following the date of the issuan a of th I approval of the Certificate of Construction Compliance of the original system or any repairs theret9e) Signed: Address P.E. R.A. Date it 1s��� License # i 105L Y V 10541 APPROVED YOR CONS Cte O Tis approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew p it. Approved for scharge of domestic sanitary sewage only. By: /�u�r� -C. Title: kpk� Date: w/7copyy A- HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER_ WELL C .:.Please print or type .........- k> . CHD Permit - V -tom: =� �. Well Location: Street Address: TownNillage Tax Grid # 0 MI) 12U T ASR VA u e Y Map 41.5 Block J Lot(s) Well Owner: Name: Address: (/• P,0, Six 14 MA9aPAC. 14, Y. i 0641 Use of Well: Residential Public Supply Air /Con eat Pump Irrigation ' 1- rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _,g_ gpm # People Served _4 Est. of Daily Usage g 0,0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason V L for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? .............. ............................... ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision 5 r� P O� ®A NG, ¢�iQ ��1� LQ Lot No. 40A Water Well Contractor: 14 ,E 9-"J4 Z I. Address: tt7• 1.l.G J' Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: TownNillage Distance to property from nearest water main: Aj Proposed well location & sources of contamination to be provide separate shee plan. Signature:.:. _ .: .- PERMIT TO C& TRUCT/A WATER WELL v This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear.'2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permit Issuing Official- Grrr,�•��T Date of Expiration A„ 2.- Title:. ! e.P..- Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 -.. :.......,.. ... � H PUTNAM COUNTY Y EPA$Tl T. F �� ATTENTION DIVISION OF ENVIRONMENTAL HEALTH SERVICES djOSEPH 0 GENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. �W -25- v2 PCHD Construction Permit # Located: 25 r—)Ag rrx G- (T) (V) lb-t1 V4 Owner /Applicant Name: R�a5E 54KWIZ, TM 4. Block 6 Lot W Formerly: O'D� Subdivision Name: rA&F of QcAo,�6 BP,) �W Subdivision Lot # O y C4- Is system fill. completed? ''( ` Is system complete? Uer-� Is system constructed as per plans? Is well drilled? Is well located as per plans? U, Are erosion control measures in place? ` �S Date: Date: (� D Date: I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: Certified by: PE RA Degign P ofessional Address: Lic. Comments: Form FIR -99 V. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Py- 3 5 - n o � J Located at OAKRIDGE DRIVE ! Town or Village PUTNAM VALLEY Subdivision nam(5TH MAP OF Subd. Lot # 5 0 4 Tax Map41 . s Block 1 Lot g Date Subdly s1onGAppro e LAKE 7 � / 19 4 A Renewal Revision x Owner /Applicant Name Robert Baxter Date of Previous Approval 9/ 2 0/ 2 0 0 0 Mailing Address p n Anx 147, Mahapac, Now York Zip 10541 Amount of Fee Enclosed =9 Building Type Res i d i l Lot Area 0 _ h 1 No. of Bedrooms -1 Design Flow GPD h n n Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 5 0 gallon septic tank and 300 I f n f Other Requirements: 7 ft. curtain drain and 1 5 ft- _ of hank run fill To be constructed by not selected Address Water Sunoly: - -- Public. Supply From.. Address or: X Private Supply Drilled by Norman Anderson n Address Hanger "St "r�et Puttnam Valley. I represent that I am wholly and completely responsible for the design and location of the proposed syst0em(SI and that the separate-sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place'in good operating conditi part of said sewage treatment system during the period of two (2) years in ¢mediately following the a of the issu ce of a approval of the Certificate of Construction Compliance of the original system o repairs the e Signed: P.E. R.A. * * Date 8/8/2002 Addr s 2e s; oot o License # 11056 APD FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewag eatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. )Approved for discharge of domestic sanitary sewage only. By: Title:j )r Dated Z. White c py - HD Vile; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BRUCE- •Rc +0LEY Public Health Director SW jd -, z LORETTA MOL,IAIARI R.At., 1VI.S.N.' Associate Public Health Director Director ^r. Patient Services DEPARTMENT ENT OF B EALT H 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 . WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIIFI�C WAVIER NAME: ADDRESS: /y L- SITE LOCATION: oar, &- DATE: STAFF PRESENT: SPECIFIC WAVIER REQUEST: . - -?, -,?o-. DOES. THE PROPOSED VARIANCE REQUEST POSE A HEALTH ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? S NO DISCUSSION REQUEST APPROVAL OR DENIED APPROVED REASO OR DENIAL DIRE ;TOR PUBLIC HEALTH (SPECWAIVER) HAZARD OR DENIED DATE: ^, NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requlrements of Part 75 and Appendix 75- A,10NYCRR . for lndlvldual Household Sewage Treatment Systems Name of Applicant !1 s Address 8 0 l �1 / / I/t ' � d 1 city/Town � /` l nStaia Zip Site Location NoQa V ri s Ct e- �� V� PLA1 -. Y,� lei 1 V V ) D.S 7 q Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive. slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. �. Other (explain) ........... f�l��,.. �.. �. G° �......... �✓.. �.. �........... �....... ���. �4. �...... �CT .� .........................�, a�a �Cti. ............................................................................................................:........................................................................... ............................... 2. Proposed design or conditions of waiver: ............................................................................:................................................................................... ............................... _................ ............................... o..� �t.. £x�..r�.:.... S.,N,o w.N.:...... h. .............�. o �..E, ................................ ............................... 3. The proposed design may have;the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination., Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. 4. . Other(explain) ... : ..................................................................................... :....................................................... :................. Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. in accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the ' suing official fora change in conditions for which this waiver was granted. :..........:............................ ............................... REPRE EN7ATIVE 0 oMMlss�oNER of HEALTH ORIGINAL -Local Health Agency COPY - Applicant/Design Professional oarE feat 12 c L L PROJECT I.D. NUMB 617,21 ER Appendix C State Environmental Duality Aevler; SHORT Et WR-O.1 NI-EUTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicant or Project soonsor) t® SEOF I.. APPLICANT /SPONSOR 2 PROJECT NAME " Robert Baxter Robert Baxter 3. PROJECT LOCATION: MuAlclpanty Putnam Valley County Putnam a. PRECISE LOCATION ISlreet address and road Inleraections, prominent IanOmarks, etc.. or provide mapl Oakridge Drive S. Is PROPOSEt) ACTION: ONew ❑ Excenslon ❑ Modlllca tlorvdleration S. DESCRIBE PROJECT BRIEFLY: New' House T. AMOUNT OF LAND AFFECTED: Initially _ 0 F 1 acca Ultimately 0_61 acre !. WILL PROPOSED ACTION COMPLY WITH EXISTING 20NING OR OTHER EXISTING LAND USE RESTRICTIONS-) YM ❑ No II Nd. deeerft "fly 9. WHAT 13 PRESENT LAND11 USE IN VICINITY OF PROJECT? Ralr!ertlial U Induatrlat 0 Corfirimmlal ❑ Agriculture ❑ Park/ForesttOpen space ❑ Otnar Deserl0a: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY IFEDERAL. ' STATE OR LOCIILI? 13Ya L-1 No It yea. list agoncy(a) and pam111600►o•els w Putnam Valley Highway and Building Dept. It. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yea ]G.I me 11 fy. fat ag+ncy name and parmWeVoroval 1:. AS A RESULT OF PR 11110 O ACTION WILL EXISTING PERMITIAPPROVAL REOUInE MODIFICATION? ❑ YM 0011e 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Appllesnlhponsa name: Dale•. 2/17/2002 Slgnalure: Pro' ect Architect if tt a Inn Is In the Coastal Are , and you or* a state agency, complete the oastal Assessment Form before proceeding with this assessment OVER t PART if-- .ENVIROMPAENtAL ASSESSMEN r 110 De COITrpleteO oy Agency) A. DOES ACTION EX FED ANY TYPE I THRESHOLD IN 6 NYCnn. PART 617 12' if yon. cooTdlnato ma rev%" oroceaa and %m "" FULL EAF O Y09 No 8. WILL ACTION R CEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN A NYCnn. PART 617.67 It No, a nooalrvo declaration fay be oupprll y another Involvfld agoncy. C. COULD ACTION OESI.ILT IN ANY ADVERSE EFFECTS ASSOCIATED.WITH THE FOLLOWING: (Anevrcxe may be handwtillen. It looibtal cl. Enlallno aft auslify, outface or groundwalor quality or quantity, noioo iovois, onlaling trafrlo patlorna. o011d tyonte preauchOn or 419009131. polvntlal for (M Dion, drainago or flooding problem9i Expfam briefly: C.2. Ao4thalic. o9rfcultural, archDoologicnl, historic, or olhor natural or cultural rosoureca: or coiftrvtunity or na4ghbprtioad charectoO Explain briofly: �V C9. Vo"Jallon Of founa. fish, 911011lfah or wildllfo opocloo, 9fpnlfI"nf habflato, of throotonod at ond=Vcrod 000C W07 Explain bHolly; 40 0 C4. A ewrilwunity'a onloling piano or goals oo officially odoolod, or o chango In uoo of Inlcrlolty of tt00 of tend or otfuir h IMI r000urco94 Explain brtofly Afo C8, ®rdGylh, QUOU®uonl dovolOOMMI. or ►ololod OCIMlloo Iltioly to ba Induced by I" Pop000d actW? aolaln briefly. N 4;t7 M. La" feral. phort form. eumulothra. W other effocts not 6dentifled In Cl-C97 aplaht Wtoffy. -0 tV C7. OtW I11716(Xtp (including changed In use of Minor Quantity or typo of onorgyll Exotoln twWfiy. X- 0. us THERlE, on I THERE LIKELY TO OF- CONTROVERSY RELATED-TO POTf£ fdT1A�gpVE�E ..f£Fdyl�dd84.E2d.YAL YOO 940 It Yep. eapl aln brMly PART Oil — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) M . { C:) rY C/) C F=7 C1. -< 0 INffRU m 0N&: For each advorM of-ION identifted sbovef, dete mind rxhother it to oubatintlel, large, important or othorearlas signifleanL Each affect ahould bs assessed In connection with Its (a) Setting (Lo. urtaft or rural): (b) probablllty of occurring: (c) duration; (d) Irrlever'siblMr, (o) geographic scope; and M magnitw9ta. If nec"eary, add allachmonts or rolerence Supporting materials. Ensuro that axplanaf ns Contain sufflclertl detail to ohotw that all mlovant advorw Impacto have.bootf Identi /led and Adequotoly iddrecood. O Check this box If you have Identified one or more potentially largo or elgnIfIcant adverse Impacts which (AAV "ccur. Then proceed directly to the FULL EAF and/or propare a positive declraratlon. Check this Ian Of you he" determined, based on Rho Information and analysis above and any supporting documentation, that thm proposed action WILL NOT result In any significantIadv ®rge environmental Impacts AGEO provide on attachments as necessary, the ress►ono aupperting thlo detorknation: _ -- Name of Load Aov"cy P-4 67 ype Name 0 es it iccr m Lo Aeomy I�I50 O @700n9s @ ftle of IC @t t T .p.+OfWO O ✓'r�WrW 11, @roast (rot" rct(�M�1� @ O KPT) 00twoum e/pomoo O scot in LO AeQnCy Daw 7 �PUTNAM COUNTY DEP DIVISION OF ENVIRONMF OF HEALTH AL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL '(J '4S 3 i Well Location: Street Address: TownNillage Tax Grid # Oakridge Drive Putnam Valley Map 41.5 Block 1 Lot(s) 8 Well Owner: Name: Address: Robert Baxter P.O. Box 147, Mahopac,N.Y. 10541 Use of Well:_ Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 3D 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) ' Deepen Existing Well Detailed Reason npw dwelling for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................ Yes No x Is well located in a realty subdivision? ..................................... ............................... Yes_ No Name of subdivision '5th Map of Roaring Brook Lake Lot No504 Water Well Contractor:. Norman Anderson Address: Barger Street, Putnm Valley, Is Public Water Supply available to site? . ...........................hpw yvci� 1 05m Name of Public Water Supply: n / a TownNillage Distance to property from. nearest water main: Proposed well location &sources of containing 'on to be pro vi a on separate he t/plan. i Date: _ g ® I Applicant Signature: V PERMIT TO E S RUCT A WATER WELL This permit to construct one water well as set above, is granted under provisio s of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear! 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this' property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director: Any revision or alteration of the approved plan requires a new permit. Well to be constructJbbya ell driller certified by Putnam County. Date of Issue / d Permit Is O Date of Expiration Title: Permit is Non- Transfe ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Ivan —T ©ul 12 P�OttAIECT I. ®. NuMeER 697,21 E Appendix C Sl ©to Environmenlol GumIlly Revion- �� ® �. .� So- ? ®R� @:P�VI d0� 4�.fi�:I4..�- SS.�,�WE :.,F . . ... ....... .. .... ..._... . ,.., a ....._ � ....... .� _ _ R�iR- ,._.�. _•.. For UNLISTED ACTIONS Only PART 0— mFROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPUCANT (SPONSOR 2 PROJECT NAME Robert Baxter Robert Baxter J. PROJECT LOCATION: Municipality Putnam Valley County Putnam 4. PRECISE LOCATION (Stmt address and road Inloreecttono, prom,nont lanomortts. otc.. or proviotr map) Oakridge Drive S•. 18 PROPOSED ACTION: 014ow ❑ Ex®®nsion ❑ MC)dlllctllioniallarulion W. IOIE =Rl6 E PROJECT DRIEFLY- New House Y. APAOUNT OF LAND AFFECTED: Initially n 1 acme U111malefy _. Q - Ai 1 0Qr09 0. IAfALL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE nESTRICTIONSl XW V00 0 No II No. doocrlbe towly I 0. WHAT 1$ PRESENT LAND USE IN VICIHrTY OF PROJECT? t 1 L, A4040"818 *1 u Industrial ❑ Commercial CJ Agrtculluro ❑ PortvForoctloven apace ❑ Otnor 10. DOES ACTION INVOLVE A PERMIT APPROVAL, On FUNDING. NOW OR ULTIMATELY FROM ANT OTHER GOVERNMENTAL AGENCY IFEDERAL. STATE OR LOCAU ?-^^ GY00 0 NO 11 yvG. 1191 090" 81 and tfrrrtl11®p0f*v010 Putnam Valley Highway and Building Dept, 99. DO%$ ANY ASPECT OF THE ACT1014 HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Voo Oft Of yog (tat 69 "Cy manse and PVMtVepprovDI IM". AS A RESULT O°_ FyPROP�® ACTION WILL (EXISTING PERMITIAPPROVAL REOUInE MODIFICATION? ® V©® I CttiMFV THAT THE INFORMATION PROVIDED AGOVE IS TRUE TO THE OEST OF MY KNOWLEDGE Appllcentist9on>aa �Irvty: ROBER4BAXTER. l _ r...__..__ .. _ .. Data: 9/17/2002 sl®noturo: Project A 00 a® sAlon Is In tho Coasts) A c'e, and you sm a 9t®ta equity, complete the oestel Assossmont Form begore pr ®c ®�c90rTq withQVtls u��eesSrTt ®nt OVER 9 PART 11-- F,,NVIRONMf_NrAL ASSESSMENt I I Q Oe COrrlplr_IeO Oy; Agency) A. DOES ACTION EXCEED ANY TYPE I THIIESHOLD IN 6 NYCnn. PAnT 617 127 it yes, coordinate the fOvww CWOGeea and use the FULL E A V r' ❑ Yes No e. WILL ACTION RECEIVE C00901HATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN a NYCnn. PART 617.67 Of No. a negative declaration may be Superseded by another Involved agency. ❑ Yes ❑ N� _.. „, ,..r, C..:COLBt.D.At,UQN.RE9r.oLT ffd ANq'A�YERSE'EFF�C? ASSOCIATED WITH T14F FOLLOWINt7: (Anew«• may M'handwNlten, It IagIDIf) C1. Existing all Quality, surface or groundwater quality or quantity, notes awls, existing traffic pettetns. Solid waste production at disocisal. potential for en Soon. drainage or flooding problems? Explain briefly: C2. Aesthetic, egrt<ultural, archaeological, historic• or other natural or cultural resources: or teem Mlty or ne4ghbothoW ehafeeler? Fxplun briefly. C3. Vegetation or fauna, fish, shellfish or wlldtlle Species. significant habitats. Or threatened of en0oangw9d speclee? Explain brNlly: G. A Contlflunity'S existing plant or goals as officially adopted, or a change In use or Intensity of use of tend or outs► natural resources? Explain briefly CS. Growth. subsequent dewtopmenl. or telated activities likely to be IndueeA by the ptoposed sellon? Explain briefly. CO. Long form. shorl term, cumulative, or other effects not identllled In CI-05? Explain briefly, C7. Other Impacts (including changes In use of sorer quantity or type of energy)? Explain tfrlefly, O. 19 THERE, OR IS THERE LIKELY TO sE,.CONTROVERSY nELATEO TO POTENTIAL AAVERSE'ENVrnONMENlAkCl PACTS, ?'-_� _.::, - -••• •; :. _❑.Yea s - -- ❑rag 'IP'Yaw: 'exp111it bflNlIF _. :. , - ART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTtlUCTIONS: For each adverse effect Identified above, determine whether Ills substtintlal, large. Important or otherwise significant... Each effect should be assessed in eonnecllon with Its (a) setiing (I. *1 urban or rural); (b) pmhablllty of occurring; (e) duration: (d) Ineverslblllt , (e) geographic scope; and (f) magnitude, It n"Soeeary, add attachments of reference supporting materials. Ensure that explanations contain sufficient distail to show that all relevant adversrtmpacts haw been Identified and adequately addressed. ❑ Check this box If you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed dir*ctiy to the FULL EAF andlor prepare a positive declaration. ❑ Check this box It you hew determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result, In any significant, adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determinallon: ne" er V" Hann of Arlponsiglit 011ocirf in Load AvalKy Strut;;-* 61 IttitiontilRe 016cipt on teed Aafrrcy Nark of Coma ASfnCY I atf ]it! OI 1{f9ponlr t Officer .enarurf o r� �Rarfl Ill frfnf from rVo1wnf' f officer) PUTNAM COUNTY DEPARTMENT 07 HEALTH DlVffSffON OF lENWRONM1E1` TAIL HEALTH S ERVffC1ES _ A]P]PLICATION. TO CPPN$ l U—CT A- ...WA...]ER8 .WELL., .T . please print or type PCHD Permit # Wtell Location: Street Address: Town/V Tax Grid # OAKRIDGE D TNAN VALLEY Map 41 , 5 Block 1 Lot(s) g Well Owner: Name: Address: B ° Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation Il- wimalry Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 3_0 0 gal. Raison for Replace Existing Supply Test/Observation Additional Supply D ri ing New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Welll 'Type Drilled Driven Gravel Other Is Svell site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yeses_ No Name of subdivision 5TH MAD OF ROARING BROOK T,AKF Lot No. SO Water Well Contractor: NORMAN ANDERSON Address: _gARGF.R ST, PTTTNAM VALLEY -, N Is) ublic Water Supply available to site? .................................. ............................... Yes No 10 Name of Public Water Supply: TowJilla Ditance to property from nearest water main: N/A Priposed well location & sources of contami ion o be pro %i'deon s et/plan. I�ceL...7./5./.00.. Applicant.SignaturQ: F ERI IUT T CO TRt CT A WATER WE]LV -17b permit to construct one water well as s rth above, is granted under provisions of Article 10 of the IPamam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided the within thirty (30) days of the completion of water well construction, the applicant or their designated relesentative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the reairements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form pv,ided by the Putnam County Health Department. During all well drilling operations, the applicant and/or Ord driller shall take appropriate action to assure that any and all water and waste products from such vrd drilling operations be contained on this property and in such a manner as not to degrade or otherwise c<aiaminate surface or groundwater. &?ROVEID.FOR CONSTRUCTION: This approval expires two years from the date issued unless c<ostruction of the well has been completed and inspected by the PCHD and is revocable for cause or may be waded or modified when considered necessary by the Public Health Director. Any revision or alteration mtie approved plan requires a new permit. Well to be constructed by a water well driller codified by Putnam Canty. L1g of Issue 7,0 10 Permit Issuing ial: Ile of Expiration i Title: Pl"a>t is Non- Tiransffer>rab e die copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Y, ,79 �I.. e.. .+: vui.- svw. �a.: as [..a.•�r ^3a'.v.r..- .- �- �enaK.xr �....a :.m 'y.. .. .. ...__... .. . .. � f.w .. ., n ♦ va. ....., ..vw • .. r_ � •.a .w ah.- .+.•t:...r,,..aus+ +zro.�. ..R.• -. 7'as. a /.�..aror n:.mpa �c.�..:- e��oc�.sm•: +Kr.ram.. a...z .. a• ys ae. zp . j I ,..«... h.._.. .' _ �..�. r. .�..._...� .Y «.. _..._..��.. v.,r �' ..e .r.. _. ..w-w �....«._.. _. ♦ .....w .� ..• n ....__. aI �. m �.. ....� .. .�.r� «..- .....v ... �..��.. +.•... • ti n.... .. w...a.. .. w.+ •. ♦ ...rw ... �J Public Health Director un1.r... -- ar'.iYIJC�aY�:�rove z.`�:y •e a ..• �LORETTA MOLINARI R.N.,1 `M.S.N. Associate Public Health Director Director of Patient Seryices DEPARTMENT OF B EAi.TH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 August 22, 2002 Joel Greenberg, R.A.- RFD #2,2 Muscoot North Mahopac, New York 10541 Re: Dear Mr. Greenberg: I�ITERE�j Womb, Proposed SSTS - Baxter, 0akridge Drive (T) Putnam Valley, TM# 41.5 -1 -8 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: ease provide the location of the wetland to the east of Oakridge Drive. a! Provide -100 year flood plain boundary, updated construction notes, the location of all building drains, and all wells and septics within 200 feet of the property line. _.; 9. ^_.. roovi e�erosio,cpntrol forxh construction- ofthe- hm�ls�, C4--- Current codes require that 100% expansion be provided. Since the necessary expansion area has not been provided, this proposal is not approvable. It is your right to request a waiver from this requirement by completing the enclosed waiver request form and returning it to my attention. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, 99 Shawn Rogan Public Health Technician SR: cj 4 Migict- 1"6 P_ ublic Health Director LORETTA MOLINARI 'R.N.,- :M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 August 22, 2002( Joel Greenberg R.A. y 'RFD #2, 2 Muscoot North �jrl �'� l S S Q S't ✓�^ Mahopac, New York 1054.1 / Re: Proposed SSTS - Baxter, Oakridge Drive %y6U.;1✓-ow- Iledi.y (T) Putnam Valley, TM# 41.5 -1 -8 Dear Mr. Greenberg: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: P-i "Sr W" �2 1. Please provide the location of the wetland to the east of Oakridge Drive. 2. Provide 100 year flood plain boundary, updated construction notes, the location of all building drains, -and all wells and septics within 200 feet of the property line. 3:. _......_p ovide_erosion control for the construction, of the house; *ell; and septic. 4. Current codes require that 100% expansion be provided. Since the necessary expansion area has not been provided, this proposal is not approvable. It is your right to request a waiver from this requirement by completing the' enclosed waiver request .form and returning it to my attention. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely,'. celeo �.- Shawn Rogan Public Health Technician SR: cj A 1b SENDING CONFIRMATION DATE : AUG-22-2002 THU 15:50 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE 96218562 PAGES 1/1 START TIME AUG-22 15:49 ELAPSED TIME 00'25" MODE ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. BRUCE R. FOLEY LORMTA MOLDMW R.N., M,SX. P.Wk Awth Dftw A—cftft A.Afim & ffi D"v� DAW. DEPARTMENT OF -HEALTH I Geneva Read, Brvwstm� Now York 10509 EmireotmepW Polth(045)278-6120 FU(94S)271-7921 Kur,d.g&m Vise ($45)271-fi5SS WIC(845)272-6679 F4(945)278.6065 f-HII-t-r edMfflftwh--1(84S)278-6314 Vn(645)279-6616 August 22, 2002 Joe) Greenberg, RA MWM*c,.N&wYo& 10541 Re:- Proposed SETS -BsxW,0a1oidgaDrive M Putnam Way, ThO 41.5 -1 -8 ., ry Dear W. Greenberg: Review of plans sad otbar supporting documents submitted atthin limo relative to the above regarded project ban been completed. Comments are oftbred as follows: 1, Please provide the location oftho wtdaM to the east ofOakridp Drive. 2. Provide 100 you flood plain boundary, updated oDastroction notes, the location ofaU building drains, and aff waUs and septics within 200 feet of the property line. A— 1 3. Provide erosion control for the construction of the house, vm% and septic. 4. Currant codes require that 1001/6 expansion be provided. Since the necessary expantion area has not been provided, this proposal is not 4pprovable. It is your right to request a waiver from this requhmcnt by cornpleting the enclosed waiver request fbrm and resuming it to my attention. Upon receipt of submission rrAsed to reflect the above comments, this application will be canidcmd further. Sincerely, . gff Shown Rogan Pubbo Health Technician SIL-cj a _ ..... . BRUCE _ R: FOLE- Y - .. _, .....s,... Public Health Director LORETTA 'MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road,. Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278'- 6014 Fax (845) 278 - 6648 August 22, 2002 Joel Greenberg, R.' A. RFD #2, 2 Muscot North Mahopac, New York 10541 Re Dear Mr. Greenberg: r Proposed SSTS - .Baxter, Oakridge Drive (T) Putnam Valley, TM# 41.5 -1 -8 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Please provide the location of the wetland to the east of Oakridge Drive. 2. Provide 100 year flood plain boundary, updated construction notes, the location of all building drains, and all wells and septics within 200 feet of the property line. _- ._..royide- .eroson.control for. ±__he= construction�of4fre house; well;-and-septic.' - ^� 4. Current codes require that 100% expansion be.'provided. Since the necessary expansion area has not been provided, this proposal is not approvable. It is your right to request a waiver from this requirement by completing the enclosed waiver request form and returning it to my attention. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, 94e e'.W6 Shawn Rogan Public Health Technician SR: cj -6 NEW YORK STATE DEPARTMENT OF HEALTH RI• �r�a� .��f•�:�c�rn�nit��Sanitaticn a,7d= Food- �?rctection:�,:. Specific Waiver fro m- Regiilremeri €s•bf:Part-76 and Appecndix75 -Ai- 10NYCRR for Individual Household Sewage Treatment Systems 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): • i Separation distance cannot be achieved. -] Excessive. slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. i Other(explain) ............ ............... :............................................................................. ............... ...... ............................... . ........................ :.............................................................................................................................................. .......I....................... ......... ............................... .............................. :............................................................................................................................................ _ .... .................... .... ------- .... _ ..... .. ............. .. ........................................................................................................................................................................................................................... ....... _ ...... ...................... 2. Proposed design or conditions of waiver: ............................................................................,....,................................................................................................................. ............................... . :....................:.................................................... :................................................. ................................................... . ............................... ............................................................................................................................................................................... ............................... ...._._........_.. .... . ................ _..__ ................................................................................ ....................... .... .. ...................... _................................................... 3. The proposed design may have the following limitations (check appropriate box(es)): :J Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. ' Operation of sewage system is subject to mechanical problems. Other(explain) ................................................... ............................... .................................................: .......:................_...... __. _. _....w ............._ ...W_ ..... ..... ........... ... ...... _ Additional information attached ' Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official fora change in conditions for which this waiverwas granted. ........................:.... .... ... . ..... .......... ..... .. . .... . .... . ........................... iit'mmN m"G' 'OF COMMISSIONER OF HEALTH ...................... ............................... GATE ORIGINAL - Local Health Agency. COPY - Applicant/Design Professional { PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYS,,Tl.FlmS _,: �• - _ - - 4"W : - nVIEW-SHEET-FOR CONSTRUCTION PERMIT . NAME OF OWNER:' , v STREET LOCATION: REVIEWED BY: RM, GR, AS, eQA : �j' -< -0 i TAX MAP #: (CONFIRMED) Y DOCUMENTS ( �PERNIIT A.PPLICATION- j_�(�WELL PERMIT OR PWS LETTER UUPC -97 C!�L__)LETTER OF AUTHORIZATION C__)L_)DESIGN DATA SHEET (DDS) CSC )CORPORATE RESOLUTION CJC SHORT EAF . (_JC_JPLANS -THREE SETS HOUSE PLANS - TWO SETS CJCJVARIANCE REQUEST SUBDIVISION (-)ULEGAL SUBDIVISION ' CSC JSUSDIVISION APPROVAL CHECKED U(__)PERC RATE UUF11L REQUIRED DEPTH ' (-JC_)CURTAIN DRAIN REQUIRED GENERAL. CSC _JLOCATED IN NYC WATE UUPLKNS SUB O DEP UUDE A I'ED TO PCHD C� EP APPROVAL, IF REQ'D �DEEP TEST HOLES OBSERVED PERCS TO BE WTTNESSED CAL /WXAPPROVAL SSDS ADJ, LOTS / VRJ DA ON DDS PLANS & PE 1969 NEIGHBOR NOT CATI ETI'ER BUZBA 0F.jH�BTE�rTi+`�?ATiIdN--�% OUP'` ,-TSO1L TESTING LOTS >10 OLD AGE SYSTEM PLAN -(NOR HYDRAULIC PROFILE VITY FLOW_ ,C t::5C JDESGN DATA: PERC & EP RESUL C,c,J2' 0NTOURS ElaSTIN47& PROPOSE (�f(_)DRYEWAY & SLOPES, CUT f N (REQUIRED DETAILS ON PLANS CONT'D) HOUSE SEWER - Y.." FT. 4 "0'; TYPE PIPE CAST IRON UUNO BENDS; MAX BENDS 45' W /CLEANOUT RENEWALS CAL- __)SITE NOO CHANGE) FILL SYSTEMS 0' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE FILL SPECS/ FELL NOTES 1 -5 (��FILL PROFILE & DIMENSIONS (FILL IN EXPANSION AREA UU cLAY B C�CJFILL CER ATION OTE C�C�DEPTH GAU S UUVOL. ON P AN R.O.B., UNCLASSIFIED & IMPERVIOUS C� EPARA ON DISTANCE FROM TOE OF SLOPE THE E�, LF TRENCH PROVIDED_>0 %7 60FT MAX. ( UC�PARALLEL TO CONTOURS C__)C z �_"q% M,kNSI0N-PROVIDED Le:::jT, DETAHJDUST FREE CRUSHED'STONE OR WASHED GRAVEL (, GEOTEXTILE COVER t�SEPARATION DISTANCES ON PLAN - FROM SSTS C 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL _j(_j20' TO FOUNDATION WALLS Cam( )100' TO WELL, 200' IN D 0' TO PITS C _)0100' TO STREAM, ERCO , LAKE (inc. eapan) , (x)50' TO CATCH BAS RAIN, PIPED WATER _ ... __.� -10: TO.WATERIsINEipfs = ZO')........_. __.._ .................._...___...... _._ (�50' INTERMITTENT DRAINAGE COURSE C i7C�200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS C�,dC�10' MIN TO LEDGE OUTCROP SEPTIC TANK J10' FROM FOUNDATION; 50' TO WELL WELL (L ' DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION MIN 15' TO PROPERTY LINE SLOPE (�(,.,_JUSX SOIL TYPE BOUND C)( .OPE IN SSTS AREA (S20 %) CdC�TrTE BLOCK; OWNERS' N ADDRESS (�C )REGRADED TO 15 %, IF REQUIRED TnPE/RA; NAME, ADDRESS, PHONE# DOSE/PUMP SYSTEMS ( DATE OF DRAWING/REVISION UUPUMP N TES REFERENCE UUDOSE 750 IPE VOLUMEIDOSE VOLUME NOTED TIQN OF VAATERCOUPSE--S,:P;ONDS U�DETAIL F RCE MAIN, (PIPE TYPE, ETC.) LAIuS,WETLANDS WITHIN 200' OF P.L. UC --)PIT AND - X SHOWN & DETAILED C�C�PROOSED FINISH FLOOR AND UUl DAYS ORAGE ABOVE ALARM BASMENT ELEVATIONS CURTAIN DRAIN C__)C�iGS-& SSDS'S�W7IN 200! QSS UC�STAND YIP BOTH SIDES, DETAIL �" C__)C� ' ° 20' -4 %, 25' -3 %, 35' -1 %, o 0 (�(JPRQERTY METES & BOUNDS 15 MIN >5 /o, 100 /0 - <1 /o C-JUF,RlaON COWMOLZFOR- HOUSETWELL-& C— )( --)20' MIN ISCHARGE /100' with 182 cons day discharge STERO$IQN CON- TROUU10' MIN PERFORATED PIPE 'colvmErrrs: �r a S� se ', SHEET)091Gb0 LETTER OF AUTHORIZATION RE: Property of ROBERT RANTER Located at OAKRIDGE DRIVE TN PUTNAM VALLEY Tax Map # 41 .5 Block 1 Lot 8 Subdivision of 5th MAP OF ROARING BROOK LAKE Subdivision Lot # 504 Filed Map # 3081 Date Filed 7/1/49 Gentlemen: This letter is to authorize JOET. GREENBERG a duly licensed Professional Engineer or Registered Architect xxx to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the - proyisons of Article 145 and/or 147 of the Education Law, the: Public health Law, and the Putnam County Sanitary Code. v ' Countersigned: P.E., R.A., # Mailing Ad e; �9 . �O - .. -,a- nt A 9F' N6� Mahopac State N. Y. Zip 10541 Telephone: 845 6 2 8- 6 613 Very truly yo A no r ACa- Signed: �- p (Owner of Property) Mailing Address: p, o, Box 147 Mahopac State . N _ v _ Zi5 Telephone: 845 621 -8562 Form LA -97 y � BRUCE R FOLEY L M.S.N. Public Health„ Director�C? - �4 _ Associate Public Health Director. N Y 61recl6r of Pahint Services DEPARTMENT OF HEALTH ? I Geneva Road Brewster, New York. 105.09. Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914)278-6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 COVER SHEET PROJECT (Owners Name) :O��C- STREET: �Wi ,I ICIPALITY: �U`T �a TAX MAP NUMBER: 8 DESIGN PROFESSIONAL: DATE: 1 REVISION REQUESTED ADDITIONAL INFORMATION OTHER 07/10/02 WED 10:54 FAX 9146218562 Baxter Land-Surveying 9 001 n � ®� Lartd Sum " An county Building P.O. Box 147 Mahopac® N.Y. 10541 (845) 621 °5562° phone / fax Fax Transmission Cover Sheen This transmission consists of page(s), including the cover sweet. if you do not receive all the pages call (545)621m5562a fV ium I9 `s ® e RG46kS&' Z--7/, 4UA77' I' Clum— 0?76'r- A CA�Lf— � $9® Eo o IPoLoSo t �Qpn s O 17 C. s To f5 or aurN lv�obJ d��f.3� i 8� VS.LO i ITl,YY1`d- T+� is o Fl ". lhK 763s' A �� •! r Lo Cb n y s4 222, 74 a, cn TY r f `rt e Z jo oj i 0 1 N 4978,10' W ' J 26a25' n N FRAME' 0 HOU,� N I t. CDA )C r&7F- 77,n ep DINING ROB 0 KI MHEN I Eo� BEDRCO i I 0— F UWNG ROOM FOYER COAT FIRST FLOOR PLAN 8WR00A P.2 rA to be con►wf6d to any room whw. 2 be&o0me are bult, on second story - — .— tiv -La/L PUTNAM COUNTY DEPARTMENT OF HEALTH ROUSE PLANS APPROVEDIOR BEDROOM COUNT ONLY9 InRoftooms- 'ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE PLAN"IUST K SURAUTTEA) TO THE PCDOH FOR APPROVAL I'm 3 -ofk BRUC,E ..R..- F .LEY.. _.. _...... ,. Public Health Director LORETTA _MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road t Brewster, New York 10509 "Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678. Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 = 6648 September 14, 2000 Mr. Joel Greenberg, RA RFD #2, 2 Muscoot North Mahopac, New York 10541 Re: O'Dell, Oakridge Drive (T) Putnam Valley, TM# 41.5 -1 -8 Dear Mr. Greenberg: * L4(74' — - - -The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this. Department on September 7, 2000 is complete. As noted on all previous letters of incomplete application/comment, I have asked for the basic required notes to be completed with the reference to "Putnam ". Plans as received September 7, 2000 lack the notes being completed. Please complete plan and resubmit for review and approval. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2157. ABS:cj Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer a -r% d"a \ BRUCE R. VOLEY _._.. ..._ . _ .. Publk Health Dirnctor - LORETTA MOLINARI ILN..' M.S.N. Astoetate Public Health Director Director of Pottent Servtca ' DEPARTMENT OF HEALTH ' 6iD 1 Geneva Road _ Brewster, New York 10509 Environmental Htalt h ,(843) 278.6130. Fax (845) 278 - 7921 Nursing Services (843) 278.6558 WIC (845) 278 -:6678 Fax (843) 278.6083 Early intervention (845) 278 - 6014 Praehoel (84P 278.6082 Fax (845) 278 - 6648 August 29, 2000 ?; o (3 Joel Greenberg, RA 2 Muscoot North, RFD #2 Mahopac, New York 10541 Dear Mr. Greenberg: Re: Application to Construct a Subsurface Sewage Treatment System on Oakridge Drive, O'Dell (T) Putnam galley, TM# 41.5 -1 -8 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on August 17, 2000 remains incomplete. Please be advised that the following information is required before the Department may continence its review. Documentation: DK- ppt a1 - OgIW6 O l ft IMU9 LPIC07 6 - 7. g oN64 b Plan: 04, 3. 6h- 4. Complete "Putnam" in Basic Required Notes. 0�, 5. Remove all details from plan detail sheet that are not applicable and "X" out. + There are more details "X" out than applicable on plan. This office reserves its right to further review and will do so upon receipt of "revised" plans. I 'd IZ6L8L MI 'ON Xdd HZ ANd LO WVNfld Yid 11:01 HA 00 -H -MV The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department win notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is suificient`grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at (845) 298 -6130 extension 2159. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Z d IZESLZ� I6I 'ON Xbd KIM ANd L3 WVNnd KY Z� :O I QdM 00- 6Z -511b o �O The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department win notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is suificient`grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at (845) 298 -6130 extension 2159. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Z d IZESLZ� I6I 'ON Xbd KIM ANd L3 WVNnd KY Z� :O I QdM 00- 6Z -511b 09/17/2002 13:55 8456282807 JOEL GREENBERG .JOEL GREENBERG, RA, NcAm MUSCOC T ROAD NORTH MAHOIPAC, NON YORK' 10541 -2=9 I ' 845 - 628 6613. FAX 845 - 628.- 28,07, L jillgamdOmsbwebilat DATE: TO: r RE: f �o bei -k ATTENTION: 7e- re0,so, FAX NUMBER: T�r - lq2 I FROM: t G ce-e6 -,p e n COMMENTS: U TOTAL NUMBER OF PAGES INCLUDING THIS TRANSMITTAL SHEET_ Z PAGE 01 IF YOU DON'T RECEIVE ALL PAGES OF TRANSMISSION, PLEASE CALL US AS SOON AS POSSIBLE. C;;=p _ q % _ ^,DMMD TI IC 4 -Z. C/I TM • O/1C_ J70 _ 70, A A IAMP' . 111 ITA U1M /^P11 II mw Mrm^llTMrA IT nr- Pl A •09/17/2002 13:55 8456282807 JOEL GREENBERG PAGE 02 '.lalli� t�8Y1 @rvgl la ✓FMECT B.D. MUMMA 611.21 SHORT ENVORONMENTAL ASSESSMENT FORM ..:. .. �. .> . SPaca fEnni000trltoroY�O ®sI�P9Yq � ®�i ®p; For UNLISTED ACTIONS ®n#y • PAR? i— PROJECT UFVFORMATION (To be eofrfplelcd by Applicant or Prejeci sponsor) I.. A"UCA"T 15POPISOA 2 PROJECT NAME Robert Baxter Robert Banter • �. �ae�r. LocATlola: Bewk a. PR 01311 Putnam: Valley Counly Putnam (. trao' adarous f1R4 to" I"Mrsect*na, pfommon/ I�rtOm ®rft9, alc.. or BfOvfgp mAPI Oakridge Drive �. YS �4CIP�E® Il4"rY ®Pa: @. PAWICT BRIEFLY: 4 New House C3 (1 QodIFIcallott alfwat{on F. Aw"T or "ID A PecTw. IV n . n_ � oEr�9_ (�IdMOIr+IV n Fi 7 Ocrm9 Q'. "LL DOSED ACTION COMPLY WfTH EXISTING ZONING OR OTHER EXISTING LAND USE REStRICTIONS7 TM ONG of Pao, 68OWN tl giv R. WHAT 6 PSENT LAND USE IN VIOPBi T OF PROJECIN - U Aegf talllp0 0OflAbutlwe0 (3comffmcial G AEftcufluro 0 �arsJ�areov A parse@ ❑ Otfwr / ®. D= ACT1t31N IPM LVE A PtAMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER P!®VE„ RI4MFNTAL AGENCY IFEOERAL, 97ATI! ON U)CAL11 BTa" O A91a 04 tie. 118f a@otcv,11 fame t>eo�IUav ®lo o Putnam Valley Eig$way and Building Dept. 91. OM ANY ASPECT OF TDIE•AC7101 HAVE A CURRENTLY VAL10 PERMIT OR APPROVAL? 0 yea we BI ws tai o®,ewy mum A,ed p1+Ormlf awmi •I$. AS to T OF Ate N QUILL MUSTING PERMITIAPPROVAL REQUIRE MODIFICATION? I CMFT TWAT THE ONFORMAT16H PROVIDED AWOVE IS TRW To THE ®EST OF My KPIC"LEDde. Are ®l�,III� raat� omloc 911712002 sIp'a ©Ilram PRAL Pro' ect Arch ' teGi: 8E f@ s jcn Is Vn the CoYI al Arel, geld you ar'0 o owto 17pacy, eamptety tho ®astag A9a ®ssment Farr before proc®oOng with No 0-- Masmeni OVER 9 TI IC 47-q4 TFI : A45- ?7R -79 ?1 NAME• PI ITNAM rni INTY nFPARTMENT OF P.___2 b� PUTNAM COUNTY DEPARTMENT OF HEALTH N .OF ENVIRONMENTAL HEALTH SERVICES •..0 n •a., r...... t SERVICES, ......i: .. ... .�. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # �EV- 3 �5 0-0 Located at OAKRIDGE DRIVE Subdivision name 5TH MAP OF Subd. Lot # 5 0 4 RO�1gz1VG , BROOK LAKE Date Subdivision Approved 7/1/49 Town or Village PUTNAM VALLEY Tax Map 41.5 Block 1 ' Lot g Renewal Revision Owner /Applicant Name BETTY O' DELL Date of Previous Approval Mailing Address WICCOPPE ROAD, PUTNAM VALLEY, 'NY Zip 10579 Amount of Fee Enclosed $300.00 Building Type RESIDENTIAL Lot Area®, 691 No. of Bedrooms 3 Design Flow GPD 600 AC. . II Fill Section Only Depth 1, Volume PCHD NOTIFICATION IS REOUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and 300 LF OF LEACHING RXNXN8 FIELDS 6FT O.C. Other Requirements: 7 FT CURTAIN. DRAIN& 1 .5 FT OF BANK RUN FILL To be constructed by NOT SELECTED Address Water Supply: Public Supply From Address " or:" Private'Supply Drilled by NORMAN ANDERSON 4 Address RARGER STREET ^ PUTNAM VALLEY, NY 10579 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to, the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, hits successors, heirs or assigns by the builder, that said builder will place in good operating conditiokany part of said sewage treatment system during the period of two (2) years immediately following the d*V of the issu*eaf the approval of the Certificate of Construction Compliance of the original system or any repairs Signed: Address P.E. R.A. * ** Date 7/5/00 License # 11506 APPROV"D OR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new Mpe A ved ch a of domestic sanitary sew ge only. By: Title: ( Date: 160 1 0-0 White copy - HD File; Yellow copy - Building Inspector; Pink co y - Owner; Orange copy - Design Prof ssiona Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # WStreei�ddress:�_::.� all L• oeati�:.;::. �..: : w:...TownWillage :,..,.,.:.:.:- ..TaxEtid ..;.:.:.._;:_ .::..:..:........_...�.... �:* . Y1 lWell OAKRIDGE DRIVE, PUTNAM VALLEY Map 41 . 5 Block 1 Lot(s) 7 O ner:. Name: Address: BETTY O'DELL WICCOPPEE RD.r. PUTNAM VALLEY, XXXJ N.Y. Use of Well: x Residential Public Supply Air /Cond/Heat Pump Irrigation 1 rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield�Sought 5 gpm # People Served 4 Est. of Daily Usage 300 gal. Reason for. X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing.Well Detailed Reason REPLACE EXISTING WELL for Drilling Well Type X .. Drilled Driven Gravel Other Is well site subject to flooding? ............................................:.... ............................... Yes NoX Is well located in a realty subdivision? ................ Yes X No Name of subdivision '5TH MAP OF ROARING BROOK LAKE Lot No. 505 Water Well Contractor: 'Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: 14 /A Towl>m ag Distance to property from nearest water main: N/A _ Proposed well location & sources of contaminatiM be pro d on sep rate s eet/plan.: : Date: 7/5/00 Applicant Signature: PERMIT TO C RUCT A WATER WELL This permit to construct one water well as set fol above, is granted under provisions of Article -10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of'the New York State Sanitary Code and provided that within thirty (30) days of the; completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take apge ropriate action to assure that any and all water and waste products from such well drilling operations contained on this property and in'such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or,may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County.. :, Date of Issue Permit Issuing Official: Date of Expiration Title: Permit is Non- Transferrable White copy - HD file; Yellow copy Building Inspector; Pink copy - Owner; Orange copy - Well driller Fonn WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH �PVISION OF ENVIRONMENTAL HEALTH SERVICES �1 S'�' J�C' =ION FERMUT -p OR— SE ASE TREATMENT T SYSTEl�i PEFWIwT 0 Located at OAKRIDGE DRIVE Town or Village PUTNAM VALLEY Subdivision name 5TH MAP OF Subd. Lot # 504 Tax Map 41.5 Block 1 Lot RO][jvG., BRQOK LAgE Date , u vision Approved Renewal Revision Owner /Applicant Name BETTY O ° DELL Date of Previous Approval Mailing Address WICCOPPE ROADp PUTNAM VALLEY,, NY . Amount of Fee Enclosed $300.00 Building Type RESIDENTIAL Lot Area No. of Bedrooms 3 Zip 10579 Design Flow OPD 600 Fill Section Only Depth Volume PCIIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewer-agee System to consist of 1000 gallon septic tank and 300 LF OF LEACHING RKNZ ®E FIELDS 6FT O.C. Other Requirements, 7 FT CURTAINN DRAIN& 1.5 FT OF BANK RUN FILL To be constructed by NOT SELECTED Address Water Suppivo Public Supply From Address o ..]Private- Supply. Drilled by . zNORIRAN ANDE9!3bN -.__ Address BARGEE STREET PUTNAM VALLEYO NY 10579, I represent that am wholly and completely responsible for the design. and location of the proposed s stems and that the P Y P Y p g P P Y () separate sewaae.treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department; and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating conditio any part of said sewage treatment system during the period of two (2) years immediately following the d of the issua e f the approval of the Certificate of Construction Compliance of the original system or any repairs theret . Signed: P.B. R.A. Date 715,/00 Address . SCOO License # 11506 APPRO D ®�8 C NSTDTTMON: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the' PCH.D and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 V,q APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date 8/11/2000 RE: Department of Health Review of Proposed Se 1wigeTreatment System for Property Name: MRS. BETTY ODELL Address:. -OAKRIDGE DRIVE Town:. TOWN OF PUTNAM VALLEY Tax Map #: 41.5-.1-8 Dear PROPERTY OWNER, Please be advised that an application for a Construction Permit 'relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. -y-o-1 u- Ih-ave any ques ions, concerns or information which may bear on the Health Department's review of this application, you may call the Hem Department qt2 78-6130. truly Title/ PR ARCHITECT Received By: 55 MILL'PLAIN ROAD Address: DANBURY, CT. 06811 1 U/ Tax Map 9: 41.5-1-9 August 1997 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NOTE. Ex ct location of well with distances to at least two perman nt I#ddarks to be provided on a separate sheet/plan. Well Driller's Name -�--- Signature:�� Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Form WC -97 :L7 T'r t C) Map4l,S� Block ` Lot(s) Well Owner: Namp 4.11 —. , � �A®ddress: L Use ®f Well: 1- primary 2- secondary _X kesidential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby )Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing .0j-/ Open hole in bedrock _ Other Casing Details Total length / Length below grade C *t. Diameter in. Weight per foot �lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded .,,k, Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: Yes No _ Liner Yes X No Screen )[Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Field Test _ Bailed _ Pumped K.Compressed Air =ours Yield /O gpm ][Depth Data Measure from land surface- stytic (specify ft) During yield test(ft) Depth of completed well in feet Sao Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface F rrt w -�• fl7 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank InformatiNO Pump Type 4 Capacity N Depth AJ?O' Model 6o-Aj -& Voltage �20 HP Y2- Tank Typea�e -a Volume Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) NOTE. Ex ct location of well with distances to at least two perman nt I#ddarks to be provided on a separate sheet/plan. 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